Global Perspectives of Different Healthcare Systems and Health: Income, Education, Health Disparity, Health Behaviors and Public Health in China, Japan and USA

Abstract

Introduction The recent, steady increase in healthcare spending is a notable phenomenon in all countries. The phenomena in China [a national health insurance system], Japan [a universal health insurance system] and Yamada T, et al. Abstract Increasing national healthcare spending due to an aging population is a rising burden on society and the economy. Under pressure to improve healthcare systems, it is important to evaluate different healthcare systems including the national healthcare system in China, the universal healthcare system in Japan, and the mixed healthcare system in the USA. In the different health insurance frameworks, it is imperative to shift from a cost-based fee-for-service system to a capitation system. Health insurance is generally designed to mitigate financial burden, which leads to equality of healthcare service access and thus prevent health inequality. From a public health perspective, health education improves health knowledge and skill which is profoundly associated with an improvement of health literacy. An increase in health literacy levels is related to a healthy lifestyle, and then an increase in the health of the population and sustainable notional outputs. This research attempts to address the problems that arise when changing health policies, i.e. healthcare system, on health considering the effects of difference in income, educational level, and health behaviors on health and health disparity. Objective: The purposes of this study are: (1) to empirically identify decision-making preferences about preventative behaviors, i.e. breast cancer prevention by different health insurance framework; (2) to evaluate disparity of health outcomes, i.e. different healthcare financing; and (3) to investigate health outcome disparity based on income and education in the different healthcare systems among China, Japan and the USA. Methodology and data: A Bivariate Probit model is used by controlling for socioeconomic , demographic and healthcare financing factors to investigate health outcomes by different healthcare programs in China, Japan and the USA. The data comes from the China Economic, Population, Nutrition, and Health Survey 2011 Adult Questionnaire [about 30 thousand samples]; The Global Centers of Excellence (COE) Survey [about 5.5 thousand samples] conducted in 2011 by Osaka University in Japan; and Behavioral Risk Factor Surveillance System 2013, US [about 50 thousand samples]. Logit and OLS regression analyses were conducted to examine health and healthcare prevention behaviors and income and health disparity. Results: The findings suggest that there is clear-cut evidence about behaviors of preventive care by different health insurance frameworks among the three countries; an objective measure of health behavioral outcomes (breast cancer prevention) is significantly influenced by different healthcare financing and policy; A nation with health disparity (general health) is based on income inequalities and different educational level causes health disparity. Healthy lifestyle stems from higher health knowledge and depends on involvement by a modern and market-oriented healthcare delivery among the three countries. Conclusions/implications: A development of human capital, i.e. health stock, will reduce government healthcare spending. Insurance coverage is an important factor to increase the health of the population, i.e. longevity. Managed healthcare financing is a strategic policy to constrain ever-rising healthcare costs. the US [a mixed health insurance system] are no exception. Despite an increasing Gross Domestic Product, the steady increase in total expenditures on health as a percentage of GDP for the past two decades is remarkably evident in table 3. A rapid upsurge in the share of public health expenditures to national total health expenditures in Japan is a far larger share than those in China and the US. Higher spending appeared to be largely driven by the universal healthcare structure and the cost-based fee-for-service healthcare system in Japan. For the US, the relatively small share of public health expenditures as percentage of total health expenditures is due to the mixed healthcare system with a swift shift from the traditional fee-for-service of cost based to the managed care structure. The low government healthcare expenditures are due to an early stage of the national health insurance system with the cost-based fee-for-service system in China. Despite a large increase in healthcare expenditures and longevity in China, Japan and the US, health disparity among people and among nations persists [1-3]. Surprisingly however, the healthcare expenditures per capita illustrate similar trends in China, Japan and the US in table 1. The large per capita expenditures of the US are due to the high cost of medical innovation with technology and higher healthcare prices without the government intervention in the healthcare industry. Under the national healthcare system in China, a small amount of per capita healthcare expenditures is anticipated in its future expansion. Increases in healthcare spending due to an aging society are an urgent issue to be resolved. The rapid increase of aging in three countries has seen a rise in the dependent elderly, population age 65 and over in table 2. This will especially cause a shortage of labor supply, a weakening of the national pension system, and expansion of the use for healthcare resources. Japan has almost 27% of its population age 65 and over in table 2. China demographically still has a young population structure and has had one for the past two decades. It has increased about 5 percentage points in China, while it is about 12 percentage points Japan. The US growth rate has been slow. In aging, people are affected by chronic disease, and aging causes a loss of health stock. The loss of health stock includes losing physical strength and durability, a fast health depreciation of health, and a resultant loss of immunity. Older people in the US are the most likely to report one or more chronic condition. There are 31.5% of Ameri-cans with multiple chronic conditions. In addition, 68% of US adults age 65 or older have at least two chronic conditions [4]. China has also had similar experiences. Diabetes has been increasing in China and leads to heart related diseases. About 533 out of every 100,000 residents died from chronic disease in China and chronic disease caused 86.6% of death by cardio-cerebrovascular disease, cancer, and chronic respiratory disease [5,6]. Wang et.al, also proved the afore-mentioned general evidence by the survey with 1480 people (59.4% women and 40.6% men living in a rural community) aged 60 and over in Shandong Province. The overall prevalence of chronic multi-morbid disease is 90.5% [7]. It reveals a great prevalence of chronic conditions among the population in China. Despite spending more on health care with advanced medical technology relative to China and Japan (Table 1), the US shows poor health outcomes with a relatively short life expectancy (Table 2). Healthcare expenditure in the US far exceeds that of China and Japan for the past decades (Table 1). Regarding the healthcare system, the US has a mixed health insurance system and the US people spend more money on healthcare than China with the National Health Insurance system (NHI) and Japan with the Universal Health Insurance system (UHI) in table 1. In contrast, China dedicates a relatively small share of public health expenditure to total healthcare expenditures compared with the US and Japan (Table 3). It is interesting to do cross-national comparisons to evaluate the performance of the US, Japanese, and Chinese healthcare systems, and to assess health behaviors and health outcomes among different health insurance programs, especially issues related to health disparity. But little is known about how the free-competitive economic system has sustained health and produced income disparity. Under the free-competitive economic system, the socioeconomic system has generating an expansion of socioeconomic disparity with economic development. The economic disparity, in turn, causes and/or creates health disparity in different healthcare systems [8]. Objectives of this study are threefold. (1) How is it possible to develop a sustainable health with in different healthcare scheme? (2) What are influential factors of health behaviors, i.e. preventive care in different healthcare systems among the US, Japan, and China? (3) How can we explain health disparity among people? A cross-national research is needed to better understand the relationship between healthcare systems, health behaviors, and socioeconomic factors, as well as other health determinants such as healthy lifestyles and health literacy. It is imperative to profile health, to sustain good health, and to mitigate ever-increasing health disparities among countries and their population.